Ask the Doctor: PrEP 101

Q: My husband is HIV positive and has been undetectable for years. I get tested every six months. Should I still go on PrEP?

A: You’ve probably heard about the “Undetectable = Untransmittable,” or “U=U” campaign. U=U sprung up after broad scientific consensus that people who are living with HIV (are HIV positive) and who have consistently had a viral load that is so low it’s undetectable by standard lab tests cannot transmit HIV to their sexual partners. U=U is a game changer for public health and the peace of mind for serodiscordant couples like yours. If your husband truly has an undetectable viral load, you’re not going to acquire HIV from having sex with him.

That being said, “U=U” makes your individual HIV risk a mutual responsibility between you and your husband. These are some questions only you can answer: Do you need that extra level of security PrEP offers? Do you and your partner know for certain that he’s undetectable? Do you have other partners? If so, are you sure they’re HIV negative and/or also undetectable? These are important conversations to have together, as even within healthy partnerships there are often different levels of communication about health and definitions of monogamy. “U=U” is solid science, but PrEP puts the control in your hands.

A: It is great to hear that you’re thinking about starting PrEP (Pre-Exposure Prophylaxis) medication for HIV prevention. Trans men are often left out of HIV prevention conversations, and that needs to change. Many trans men unaware of their risk and quite often many healthcare providers providing care to trans men don’t talk to their patients about HIV risk or prevention.

The short answer to your question is no; PrEP should not interact with any gender affirmation-related hormones, including Testosterone. Many people who take PrEP are simultaneously in care for gender affirmation. However, for PrEP to be effective you need to take the medication every day to get the full prevention benefit, and it doesn’t protect you from other sexually transmitted infections. We recommend the same screenings we provide to cisgender patients, and we expect minimal (and similar) side effects. Congrats to you for taking control of your health.

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